Linda Jonides, BS, RN, CPNP Private Practice with Dr. Allen Dumont Ann Arbor, Michigan
Carol Rudy, MPH, ARNP, CPNA Rockwood Ctinic Pediatrics Spokane, Washington
Sally Walsh, BS, RN, CPNP Pediatric Associates of Norwood Boston, Massachusetts
. 8-Year-Old
Girl With Short Stature
n
Carol Rudy, MPH, ARNP, CPNA
. SUBJECTIVE DATA
’ OBJECTIVE DATA
Shelia, an 8 5/12-year-old girl, is seen by the PNP for an initial well-child examination. When asked whether there are any concerns, her mother states she thinks that Shelia is not growing appropriately. She has worn the same shoes and clothes for 2 years. Shelia’s 7year-old sister is now taller than Shelia.
Physical examination reveals a small, cute, cooperative, girl. Weight is 45 pounds and height is 44?4 inches, both well below the 5th percentile for age. She exhibits no dysmorphic features. The remainder of her examination, including funduscopic and visual fields by confrontation, is completely within normal limits. Your assessment is short stature.
. PATIENT HISTORY Birth and Development: Shelia was born at 40 weeks’ gestation to a healthy 24-year-old mother who was gravida II, para 2. Her mother denies being ill, smoking, drinking, or using other drugs during the pregnancy. Birth weight was 7 lbs. 9 oz.; birth length was 20% inches. She had no congenital anomalies or neonatal problems. Previous Illuesses: Shelia has had recurrent otitis media, and she underwent hernia repair at age 2 years. Shelia has migraine headaches; she sees a naturopath. Occasionally, Shelia takes acetaminophen. Family History: Mother-5’5”; Father-5’10”; Maternal Grandfather-6’2”; Maternal Grandmother6’0”; Paternal Grandparents heights unknown. Four Maternal Aunts -5’2” to 5’6”; Maternal Uncle5’ 10”. Four Paternal Uncles whose heights are unknown; however, one has “short legs and long trunk.” History is otherwise negative.
Social History: Shelia and her siblings live with both parents. Their income is adequate for good nutrition. Mother denies any significant stress or drug abuse in the family. History is negative for mental/emotional illness. JOURNAL
OF PEDlP\TRlC
HEALTH
CARE
1. What additional data Zrnecessay to determine whether
Shelia’s size L a mrmzl variant? 2. What criteria d4.1you use to determine whether Shelia has a nomzalgrowtb variation? 3. What is the next step in your assessment? 4. Prvportknal short stature my have ifs onset during the prenatal or postnatal period. When do you believe Shelia-kgwwtb failwe began, and why? 5. What laboratmy and radiographic studies are appropriate? 6. What other data would be very helpjid? 7. What ?j the sa&ajicana of the somatomedin level? 8. What shoadd the PNP do next? Answers
on page 233.
223
Carol Rudy, MPH, ARNP, CPNA Rockwood Ctinic Pediatrics Spokane, Washington
Sally Walsh, BS, RN, CPNP Pediatric Associates of Norwood Boston, Massachusetts
. 8-Year-Old
Girl With Short Stature
n
Carol Rudy, MPH, ARNP, CPNA
. SUBJECTIVE DATA
’ OBJECTIVE DATA
Shelia, an 8 5/12-year-old girl, is seen by the PNP for an initial well-child examination. When asked whether there are any concerns, her mother states she thinks that Shelia is not growing appropriately. She has worn the same shoes and clothes for 2 years. Shelia’s 7year-old sister is now taller than Shelia.
Physical examination reveals a small, cute, cooperative, girl. Weight is 45 pounds and height is 44?4 inches, both well below the 5th percentile for age. She exhibits no dysmorphic features. The remainder of her examination, including funduscopic and visual fields by confrontation, is completely within normal limits. Your assessment is short stature.
. PATIENT HISTORY Birth and Development: Shelia was born at 40 weeks’ gestation to a healthy 24-year-old mother who was gravida II, para 2. Her mother denies being ill, smoking, drinking, or using other drugs during the pregnancy. Birth weight was 7 lbs. 9 oz.; birth length was 20% inches. She had no congenital anomalies or neonatal problems. Previous Illuesses: Shelia has had recurrent otitis media, and she underwent hernia repair at age 2 years. Shelia has migraine headaches; she sees a naturopath. Occasionally, Shelia takes acetaminophen. Family History: Mother-5’5”; Father-5’10”; Maternal Grandfather-6’2”; Maternal Grandmother6’0”; Paternal Grandparents heights unknown. Four Maternal Aunts -5’2” to 5’6”; Maternal Uncle5’ 10”. Four Paternal Uncles whose heights are unknown; however, one has “short legs and long trunk.” History is otherwise negative.
Social History: Shelia and her siblings live with both parents. Their income is adequate for good nutrition. Mother denies any significant stress or drug abuse in the family. History is negative for mental/emotional illness. JOURNAL
OF PEDlP\TRlC
HEALTH
CARE
1. What additional data Zrnecessay to determine whether
Shelia’s size L a mrmzl variant? 2. What criteria d4.1you use to determine whether Shelia has a nomzalgrowtb variation? 3. What is the next step in your assessment? 4. Prvportknal short stature my have ifs onset during the prenatal or postnatal period. When do you believe Shelia-kgwwtb failwe began, and why? 5. What laboratmy and radiographic studies are appropriate? 6. What other data would be very helpjid? 7. What ?j the sa&ajicana of the somatomedin level? 8. What shoadd the PNP do next? Answers
on page 233.
223
